Biotechnology Healthcare - June 2008 - (Page BFAC1) Biologic Therapy Management: The Need for Value-Based Health Benefits Models A peer-reviewed white paper by THE BIOLOGIC FINANCE AND ACCESS COUNCIL A Special Supplement to April 2008 CHRISTOPHER V. GOFF, ESQ.; JOEL C. HOFFMAN, ASA, MAAA, FCA; F. RANDY VOGENBERG, PHD, RPH BFAC Co-chairs and Principal Authors CHAPTER 1 Principles of Health Insurance 3 What is the purpose of health insurance? This chapter reviews basic concepts of insurance and issues in health care financing to provide a context for discussions in the following chapters. CHAPTER 2 Perspectives on the Value of Biologics 14 This chapter defines biologics, presents an overview of drug spending trends, and looks at tools for assessing the value of health care. It concludes with a discussion of the treatment of rheumatoid arthritis, which commonly affects the working-age population, as a model for applying value judgments to a biologic therapy. CHAPTER 3 Affordability and Access 27 As more biologics enter the market, health plans and employers face the challenge of controlling costs while ensuring that biologics are affordable. This chapter discusses tools and techniques commonly employed to restrict access to biologics, and examines alternative benefit designs that may improve the affordability and accessibility of biologics for people who need them. CHAPTER 4 Efficiencies in Management and Administration of Biologics 38 In some cases, choice of therapy is driven by perceived efficiencies in drug delivery. In health care, however, one’s “efficiency” is another’s “waste.” This chapter examines factors that influence efficiency in health care. When stakeholders understand how one type of efficiency affects another, solutions that preserve access and affordability can be reached. CONTINUING EDUCATION Continuing Education Objectives 2 Answer Sheet 44 Post-Test 45 The Biologic Finance and Access Council panel (see opposite page) had significant input in reviewing this content and in shaping the analyses at the end of each chapter. BFAC gratefully acknowledges the assistance of Jack Alan McCain Jr. in drafting this monograph. This activity is supported by an educational donation provided by Amgen and Wyeth Pharmaceuticals. The material in this supplement has been independently peer reviewed. The supporters played no role in reviewer selection. Opinions are those of the panel of the Biologic Finance and Access Council and do not necessarily reflect those of the institutions that employ them, or of Amgen, Wyeth Pharmaceuticals, The Chatham Institute, BioCommunications LLC, or the publisher, editor, or editorial board of BIOTECHNOLOGY HEALTHCARE. Clinical judgment must guide each clinician in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this supplement may reflect the clinical experience of the authors or may reflect the professional literature or other clinical sources and may not be the same as indicated on the approved package insert. Please consult the complete prescribing information on any products mentioned in this publication. BioCommunications LLC assumes no liability for the information published herein.
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